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Outcome of hypospadias fistula repair
K R Shankar1, P D Losty, M Hopper
1Department of Paediatric Urology, Alder Hey Children's Hospital, Liverpool, UK. shankarkr@hotmail.com
Insights
Hypospadias fistula repair is 71% successful initially. Recurrent fistulas benefit from using unscarred tissue flaps, like tunica vaginalis or scrotal dartos, for better outcomes in complex cases.
Area of Science:
- Pediatric Urology
- Reconstructive Surgery
Background:
- Hypospadias is a congenital condition requiring surgical correction.
- Urethrocutaneous fistulas are a common complication of hypospadias repair.
- Long-term outcomes and recurrence factors for fistula repair require further investigation.
Purpose of the Study:
- To evaluate the long-term results of hypospadias fistula repair.
- To identify factors contributing to fistula recurrence.
- To assess outcomes in cases of recurrent hypospadias fistulas.
Main Methods:
- Retrospective analysis of 113 children undergoing urethrocutaneous fistula repair (1984-1996).
- Surgical techniques included layered closure, transpositional skin flaps, and use of tunica vaginalis or scrotal dartos flaps.
- Success rates were calculated per repair attempt.
Main Results:
- Overall primary fistula repair success rate was 71%.
- Larger fistulas (>2 mm) had a higher recurrence rate (52%) compared to smaller ones (24%).
- Success rates decreased with subsequent repairs (70% for second, 50% for third/fourth/fifth).
Conclusions:
- Simple layered closure is effective for primary hypospadias fistula repair.
- For recurrent fistulas, utilizing unscarred tissues (tunica vaginalis or scrotal dartos) as a covering layer improves success rates.
- Careful patient selection and surgical technique are crucial for managing recurrent fistulas.
Abstract:
Objectives To examine the long-term results of hypospadias fistula repair, the factors involved in recurrence and the outcome in cases where this has occurred. Patients and methods The study comprised 113 children undergoing urethrocutaneous fistula repair between 1984 and 1996. Most of the fistulae were closed in two to three layers, with or without a transpositional skin flap. Tunica vaginalis or a scrotal dartos flap was used in patients with inadequate vascularized tissue adjacent to the fistula. Success rates were calculated for each attempt at fistula repair until the patient was cured. Results The median (range) age at primary fistula repair was 40 (18-169) months and the median follow-up after the most recent repair 7.5 (2.3-17) years. The overall success rate of primary fistula repair was 71%. Fistulae which were >2 mm (11 of 21, 52%) were more likely to recur than were those < or = 2 mm (22 of 92, 24%). Recurrence did not relate to the initial form of hypospadias repair, to the means of skin closure nor, with the exception of multiple lesions, to the location of the fistula. The success rates of subsequent repairs were 70% at the second and 50% at the third, fourth and fifth repairs. One child was cured at the sixth attempt. The use of tunica vaginalis or scrotal dartos as a 'waterproofing' layer was limited to the third or subsequent repairs and was successful in five of six cases. Conclusion A simple layered closure with or with no transpositional skin flap is effective in 71% of repairs. For recurrent fistulae, tissues from an unscarred area (tunica vaginalis or scrotal dartos layer) should be used to cover the fistula.